TC Transcontinentalimages.transcontinentalmedia.com/LAF/lacom/stress_vie... · 2014-09-17 · Alain Marchand • Pierre Durand • Victor Haines III • Steve Harvey Received: 24

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Social Psychiatry and PsychiatricEpidemiologyThe International Journal for Researchin Social and Genetic Epidemiology andMental Health Services ISSN 0933-7954 Soc Psychiatry Psychiatr EpidemiolDOI 10.1007/s00127-014-0932-y

The multilevel determinants of workers’mental health: results from the SALVEOstudy

Alain Marchand, Pierre Durand, VictorHaines & Steve Harvey

1 23

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ORIGINAL PAPER

The multilevel determinants of workers’ mental health: resultsfrom the SALVEO study

Alain Marchand • Pierre Durand • Victor Haines III •

Steve Harvey

Received: 24 February 2014 / Accepted: 16 July 2014

� Springer-Verlag Berlin Heidelberg 2014

Abstract

Purpose This study examined the contribution of work,

non-work and individual factors on workers’ symptoms of

psychological distress, depression and emotional exhaus-

tion based on the multilevel determinants of workers’

mental health model.

Methods Data from the SALVEO Study were collected in

2009–2012 from a sample of 1,954 employees nested in 63

workplaces in the province of Quebec (Canada). Multilevel

regression models were used to analyse the data.

Results Altogether, variables explain 32.2 % of psycho-

logical distress, 48.4 % of depression and 48.8 % of

emotional exhaustion. Mental health outcomes varied

slightly between workplaces and skill utilisation, physical

and psychological demands, abusive supervision, inter-

personal conflicts and job insecurity are related to the

outcomes. Living in couple, having young children at

home, family-to-work conflict, work-to-family conflict,

strained marital and parental relations, and social support

outside the workplace associated with the outcomes. Most

of the individual characteristics also correlated with the

three outcomes. Importantly, non-work and individual

factors modulated the number and type of work factors

related to the three outcomes.

Conclusion The results of this study suggest expanding

perspectives on occupational mental health that fully rec-

ognise the complexity of workers’ mental health

determinants.

Keywords Mental health � Work conditions � Family �Social network � Individual characteristics

Introduction

Despite the large number of studies carried out over the last

two decades, there are still important debates about the

causes of mental health problems in the workforce [10, 16].

Many studies have pointed out the role of occupations and

work conditions related to decision latitude, demands,

social support and rewards. These conditions are at the very

heart of the dominant demands-control [39], demands-

control-support [40], effort-reward imbalance [66], and the

job demands-resources [26] theoretical frameworks. How-

ever, studies on the etiology of mental health problems

underscore the non-work and individual factors which are

often neglected in work-stress studies [10, 16]. Also, few

studies examine the relative contribution of work condi-

tions when non-work and individual characteristics are

accounted for, and few research design conduct joint

analyses of workers’ work and non-work experiences that

would allow us to disentangle how these many conditions

contribute to psychological distress, depression and burn-

out simultaneously.

The aim of the study is to analyse the contribution of the

multilevel determinants of workers’ mental model that

integrates work, non-work and individual factors to the

A. Marchand (&) � P. Durand � V. Haines III

School of Industrial Relations, University of Montreal, CP 6128,

Succursale Centre-ville, Montreal, QC H3C 3J7, Canada

e-mail: [email protected]

P. Durand


V. Haines III


S. Harvey

John Molson School of Business, Concordia University, 1455 De

Maisonneuve Blvd. West, Montreal, QC H3G 1M8, Canada


123

Soc Psychiatry Psychiatr Epidemiol

DOI 10.1007/s00127-014-0932-y

Author's personal copy

examination of symptoms of psychological distress,

depression and the emotional exhaustion component of the

burnout process.

The multilevel determinants of workers’ mental health

The multilevel determinants of workers’ mental health are

modelled here in response to previous work-stress models

that have failed to integrate, theoretically and empirically,

components of the social environment (i.e., workplace,

family, social network) in which are embedded workers.

The integrative model we advance views workers within

their broader social environment composed of various

structures with which they interact in their daily lives.

These interactions can be sources of pleasure and well-

being, but they can also be sources of suffering that may

affect the psychic balance. Micro–macro and agency-

structure sociological approaches define social structures

and agent personality as conditions of social action that

determine a set of constraints and resources that shape

individuals’ contingencies, locations, and opportunities [6,

7, 19, 29, 69]. At the macro level, macrosocial structures

represent social arrangements tied to the economic, polit-

ical and cultural systems, as well as to the system of

stratification, diversification, and social integration of a

society at the national level. At the meso level, structures

of daily life constitute intermediate arrangements between

individuals and macrosocial structures that organise the

basis of everyday life, routines, and affective ties. These

include the workplace, the family, and the social network.

At the micro level, agent personality represents the con-

straints and resources associated with reflexivity, rational-

ity, creativity, demography, affect, the body, biology,

representations, perceptions, motivations, habits, and atti-

tudes [6, 19, 29, 69]. Agent personality is thus not limited

to psychological traits or personality structure as under-

stood in psychology. It is an overall representation of

individual-specific conditions constructed around the body,

the mind, and the social environment. The relationships

between the agent and the social structures are dialectical

as they produce reciprocity and interaction as action

modalities that may result in unintended consequences

unanticipated by agents [7, 29]. Workers’ mental health

problems can thus be viewed as unintended consequences

of action being influenced simultaneously by social struc-

tures and agents’ constraints-resources. Constraints are

stressors that have the potential to affect an individual’s

adaptability [58] and to lead to potential imbalances in

one’s physiological and mental systems [24]. Resources are

protective factors against environmental stressors, but they

are not necessarily effective for everyone [57].

In this study, structures of daily life and agent person-

ality are at the core of our analysis. As far as work is

concerned, we may expect psychological distress, depres-

sion, and emotional exhaustion to vary according to

workers’ position and experiences in their respective firms,

and across firms. Firms distinguish themselves around

several characteristics related to their environment, eco-

nomic sector, profitability, organisational culture, human-

resources practices, occupational health and safety pro-

gramme, and so forth. Therefore, the general context of the

firm can be a source of variance in symptoms of mental

health experienced by workers. Indeed, a recent study

found that workers’ cortisol secretions, which is a hormone

associated with the physiological stress response of an

individual and correlated with mental health symptoms

[21], varied across workplaces even after adjusting for

work hours, gender, age and work–non-work days [50].

Work organisation conditions experienced by workers

within a firm can also contribute to mental health. They

relate to task design, demands, social relations, and grati-

fications [48]. Task design is about the level of skill util-

isation and decision authority workers are allowed when

performing tasks. Better mental health status has been

associated with higher levels of skill utilisation and deci-

sion authority [37, 62, 72]. Likewise, poorer mental health

has been associated with higher work demands, including

when these come in the form of physical demands (envi-

ronment and individual efforts) [15, 49, 83], psychological

demands (work pace, quantity of work, conflicts) [37, 59,

72], and contractual demands (number of working hours,

irregular work schedule) [4, 27, 68]. As for social relations

with colleagues and managers, when workers are supported

at work it is known to be associated with fewer mental

health problems [15, 43, 72]. However, abusive supervision

[31, 52, 76] and social relationships involving aggression

and violence at work frequently relate to poor mental

health status [34, 35, 49, 55]. With respect to gratification

from work, past research has shown that expectation of job

recognition and career perspectives are related to better

mental health [2], while job insecurity fosters decreases in

mental health status [15, 18, 74].

Consideration of family and social network outside the

workplace defines constraints and resources in terms of

marital and parental status, strained marital and parental

relations, levels of household income, and social support

from one’s social network outside the workplace. Fewer

mental health problems are expected when living with a

partner [4, 47, 80], in households with young children [42,

47, 79], and those that have low-strain relationships with

spouse or children [8, 23, 47], higher household incomes

[41, 84], less work-family conflicts [12, 33, 75], and greater

access to the support of social network outside the work-

place [22, 47, 73].

Characteristics of agent personality include gender, age,

physical health, psychological traits (self-esteem, locus of


123


control), lifestyle habits (alcohol intake, smoking, physical

activity), and stressful childhood events. Mental health

problems are more prevalent for women [1, 47, 80], less

with increasing age [15, 17, 47], and more prevalent when

physical health problems are reported [47, 78, 86]. Higher

self-esteem and an internal locus of control should lessen

mental health problems [28, 47, 71]. Life habits that

involve high levels of alcohol intake [5, 47, 85], tobacco

use [46, 47, 85], and less physical activity [45, 56] all seem

to increase the likelihood of mental problems. Finally,

mental health problems may be more pronounced when

stressful childhood events such as a parental death, divorce,

and alcohol or drug problems in the family were experi-

enced [47, 81].

In summary, the multilevel determinants of workers’

mental model views work factors as one possible mecha-

nism explaining workers’ mental health considering other

structures of daily life in which individuals are embedded

as well as their individual characteristics. Therefore, ana-

lysis of workers’ mental health must integrate the role of

family situation, social network and characteristics of agent

personality in order to examine the specific contribution of

workplace stressors.

Materials and methods

Data

The SALVEO study was conducted in Canada and aimed

to evaluate the contribution of work, family, individual

characteristics and social network to workers’ experience

of mental health problems. Data were collected in

2009–2012 within 63 Canadian workplaces, randomly

selected from a list of client companies of a large insurance

company. These companies were invited by their insurer to

participate in this study and those accepting the invitation

were referred to the research team. At this stage, the

response rate was 41.0 %, which is significantly higher

than the ones usually found in organisational research [9],

and the incidence insurance claims rate (2009–2012) for

mental health problems were not significantly different

between participating and non-participating companies.

The workplaces were very diverse in terms of their pro-

ducts, services, and markets, with 19 in manufacturing and

44 in the service sector. Of the participating workplaces, 22

were unionised, and workplaces’ workforce ranged

25–1,900 employees (average of 247.1 workers/work-

place). In each workplace, researchers first sent a com-

munication to inform all employees about the research

project. Then, a random sample of employees was selected

and invited by the researchers to individually complete a

questionnaire on company time (excluding lunch and break

times) using a touch-screen monitor that helped reducing

questionnaire’ completion time. Questionnaire administra-

tion was supervised and supported by onsite trained

research assistants. Participating workers signed an

informed consent beforehand and were given the necessary

instructions. Overall, 2,162 employees agreed to participate

in the survey (response rate 71.3 %, range 51.2–100 %)

and were employed as managers (9.7 %), supervisors

(6.8 %), professionals (15.3 %), semi-professionals/tech-

nicians (15.4 %), office workers (27.2 %), skilled labourers

(5.4 %) and unskilled/manual workers (20.2 %). After

deleting cases with missing values, the available worker

sample size was n = 1,954 employed individuals. The

study protocol was approved by the ethical committees of

the University of Montreal, McGill University, Laval

University, Bishop’s University, and Concordia University.

Measures

Mental health

Psychological distress was measured with the General

Health Questionnaire (GHQ) short-form, 12-item scale

[54] (a = 0.85), and depression with the Beck Depression

Inventory (BDI) 21-item scale [11] (a = 0.91). Emotional

exhaustion was assessed with five items from the Maslach

Burnout Inventory (MBI) general survey [64] (a = 0.90).

Emotional exhaustion was retained because it is widely

viewed as the most representative of the burnout syndrome

[44, 53, 65], and a recent study showed emotional

exhaustion, compared to cynicism and professional effi-

cacy, to be the most important component correlated with

workers diurnal cortisol profiles [51].

Workplace

Skill utilisation, decision authority, psychological

demands, and social support from colleagues and the

supervisor were derived from the Job Content Question-

naire [38]. Responses were based on a 4-point Likert scale

(strongly disagree-strongly agree). Skill utilisation con-

sisted of six items (ex: my job requires that I learn new

things, a = 0.80). Decision authority contained three items

(ex: my job allows me to make a lot of decisions on my

own, a = 0.79). Psychological demands were measured by

nine items (ex: my job requires working very fast,

a = 0.73). Social support from colleagues was measures

with four items (ex: the people I work with are helpful in

getting the job done, a = 0.83), and four items for the

support from the supervisor (ex: my supervisor is helpful in

getting the job done, a = 0.89). Physical demands, rec-

ognition, career perspectives and job insecurity were

derived from the Effort–Reward Imbalance questionnaire


123


[67]. Responses were based on a 4-point Likert scale

(strongly disagree-strongly agree). Physical demands were

based on a single item (my job is physically demanding).

Recognition contained six items (ex: I receive the respect I

deserve from my superiors, a = 0.82), career perspectives

4 items (ex: my job promotion prospects are poor, reverse

coding, a = 0.69), and job insecurity 2 items (ex: I have

experienced or I expect to experience an undesirable

change in my work situation, a = 0.65). Abusive super-

vision was measured with 15 items from Tepper abusive

supervision questionnaire [76] (ex: tells me my thoughts or

feelings are stupid, a = 0.91). Responses are based on a

5-point scale (1 = I cannot remember him ever using this

behaviour with me, 6 = He uses this behaviour very often

with me). Interpersonal conflicts during the previous

12 months contained five items from Harvey and col-

leagues questionnaire (ex: have you had an argument with

someone, a = 0.80). Response are based on a 4 point scale

(1 = never, 4 = very often) [36]. Workplace harassment

was measured using three 4-point Likert indicators

(1 = never, 4 = very often) from the Quebec Health and

Social Survey [25]. The respondent was to indicate whe-

ther, during the previous 12 months, he or she had been

subjected to physical violence or intimidation and/or been

the object of unwelcome remarks or actions of a sexual

nature in the workplace.

Family

Marital status was coded 1 for people married or living in a

civil union and 0 for others. Parental status measured the

presence (yes/no) of minor children in the household.

Household income was determined using a 10-point ordinal

scale (1 = less than $20,000, 12 = $120,000 and more).

Marital strains was assessed with four binary items (false-

true, no-yes) taken from Wheaton (ex: your partner doesn’t

understand you, a = 0.70) [82]. Parental strains had three

items (false/true) taken from Wheaton (ex: a child’s

behaviour is a source of serious concern to you, a = 0.60)

[82]. Work–Family conflict was measured with the Gutek

and colleagues instrument with responses based on a

5-point scale (strongly disagree-strongly agree) that dis-

tinguish both directions of the conflict [32]; the first one

being work-to-family spillover (four items, ex: my work

takes up time that I’d like to spend with family/friends,

a = 0.79) and the second family-to-work spillover (4

items, ex: I’m often too tired at work because of the things

I have to do at home, a = 0.74).

Social network

Social support outside the workplace was based on four

items (no–yes) from the Statistics Canada National

Population Health Survey [20] asking respondents if they

had a confidant, someone to count on in a crisis situation,

someone to count on when making personal decisions,

someone who makes them feel loved and cared for. The

scale was dichotomised as low (0 = 0–3) and high

Table 1 Sample descriptive statistics

Mean/

proportion

SD Min–

max

Mental health

Psychological distress 2.16 2.62 0–12

Depression 7.10 7.13 0–54

Emotional exhaustion 1.69 1.36 0–6

Work

Skill utilisation 17.72 3.38 6–24

Decision authority 8.62 2.00 3–12

Physical demands 2.01 0.97 1–4

Psychological demands 23.44 3.86 10–36

Working hours 40.64 10.75 6.5–168

Irregular work schedule 1.51 0.79 1–4

Support colleagues 12.51 1.95 4–16

Support supervisor 11.91 2.59 4–16

Abusive supervision 18.56 6.34 15–69

Interpersonal conflicts 7.38 2.23 2–20

Harassment 3.24 0.63 1–9

Recognition 15.67 2.63 5–20

Career perspective 10.36 2.39 4–16

Job insecurity 3.79 1.31 2–8

Family

Marital status (in couple) 0.69 0–1

Presence of minor children 0.48 0–1

Household income 6.93 3.38 1–12

Marital strains 0.44 0.90 0–4

Parental strains 0.21 0.57 0–3

Family–work conflicts 8.19 2.82 4–20

Work–family conflicts 9.90 3.50 4–20

Network

Social support (outside

work)

0.82 0–1

Agents

Gender (female) 0.49 0–1

Age 40.81 10.92 17

Physical health 1.06 1.30 0–10

Alcohol 5.58 7.73 0–80

Smoking 2.85 6.48 0–60

Physical activities 4.13 2.06 1–7

Self-esteem 19.36 3.45 2–24

Internal locus of control 19.51 4.58 0–28

Childhood stressful events 1.16 1.31 0–7

n = 1,954


123


(1 = 4) social support in order to correct for high

asymmetry.

Agent characteristics

Gender was coded 0 for males and 1 for females. Age was

measured in years starting at Cycle 1 and was indexed two

years for each subsequent cycle. Physical health was a

count of the number of physical health problems from a list

of 29 possibilities (ex: heart problems, cancer, arthritis,

etc.). Self-esteem (a = 0.87) was measured with Rosen-

berg’s 5-point (disagree–agree), six-item scale [63], and

internal locus of control (a = 0.84) with Pearlin and

Schooler’s 5-point (disagree–agree), seven-item scale [58].

Alcohol intake was measured using the summation of daily

drinks consumed over the last week (Canadian standard

drink equivalents for beer, wine, and spirits). Smoking was

based on a count of the weekly number of cigarettes and

physical activity was a measure of the monthly frequency

of one or more physical activities over 15 min in duration.

Stressful childhood life events were determined by a count

of Wheaton’s 2-point (no–yes) 7 items of events happening

before age 18 (ex: 2 weeks at the hospital, parental divorce,

parents’ alcohol or drug abuse, etc.) [82].

Table 1 presents descriptive statistics of the study

sample.

Analysis

Multilevel regression analyses [30, 70] were conducted on

data following a hierarchical structure in which workers

(n1 = 1,954) were nested within workplaces (n2 = 63).

The first multilevel regression model determined the

overall mean of psychological distress, depression, and

emotional exhaustion, as well as their variability by indi-

vidual and workplace. Next, the variables concerning the

work situation were introduced into the equation in order to

verify their contributions to the three outcomes before

controlling for family situation, social network and per-

sonality of the agent. The variables describing family,

social network, and the personality of the agent were then

entered by group, then together, in order to determine

whether the effects of the workplace were modified by the

other structures for daily life and/or the personality of the

agent. The model parameters were estimated by the itera-

tive generalised least-squares method (IGLS) using

MLwiN 2.26 [61]. In the analyses, all independent vari-

ables were centred on their respective means, with the

exception of the dichotomous variables. Finally, because of

the number of variables embedded in the regression ana-

lysis, all p-values were corrected for multiple testing with

the Benjamin and Hochberg method [14].

Results

Table 2 presents bivariate correlations between the study’s

variables. All mental health outcomes are correlated, with a

stronger correlation between psychological and depression

followed by depression and emotional exhaustion.

Psychological distress

In Table 3, Model 1 reports the overall mean of psycho-

logical distress, and the results reveal significant variation

of psychological distress at both workers and workplaces

levels. The intraclass correlation (q) indicates that work-

places accounted for 1.2 % of the total variation in psy-

chological distress.

Model 2 reports the associations for work variables and

indicates statistical significance for skill utilisation, deci-

sion authority, psychological demands, support from

supervisor, abusive supervision, work recognition, and job

insecurity. Model 3 controls for the contribution of family

situation factors, and psychological demands and support

from the supervisor are no longer significant. Model 4

controls for social support outside the workplace that

suppresses interpersonal conflicts. In Model 5, agent per-

sonality is controlled for and the results reveal that skill

utilisation, decision authority, and job recognition are no

longer significant. Model 6 contains all variables and

shows that abusive supervision and job insecurity are

associated with psychological distress. Moreover, some

family-related variables (living in couple, marital and

parental stress, work–family conflicts), and the personality

of the agent (sex, physical health status, alcohol con-

sumption, physical activity, self-esteem, internal locus of

control) were also statistically significant. This last model

explained 37 % of the variation in psychological distress

between workplaces and 32 % between workers. From the

1.2 % of variance that was between workplaces, the per-

centage of variation was now 0.9 % (p \ 0.05).

Depression

Using the same modelling approach, the results of Model 1

(Table 4) show significant variation in depression at both

the worker and workplace levels. Workplaces accounted

for 1.0 % of the total variation in depression.

Model 2 indicates statistical significance for skill util-

isation, psychological demands, support from colleagues

and supervisor, abusive supervision, interpersonal conflicts,

work recognition, career perspective, and job insecurity.

Model 3 includes family situation and psychological

demands and support from colleague and the supervisor,

job recognition and career perspective are no longer sig-

nificant. Family situation also suppresses physical


123


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123


demands. Model 4 controls for social support outside the

workplace. Support for colleagues is now not significant,

and social support outside the workplace suppresses deci-

sion authority. In Model 5, personality of the agent is

controlled for and the results reveal that skill utilisation,

support from colleague and the supervisor, interpersonal

conflicts and job recognition are now not statistically sig-

nificant, and agent personality suppresses physical

demands. Model 6 contains all variables and shows that

only physical and psychological demands and abusive

supervision are associated with depression. Some family-

related variables (marital status, marital and parental

strains, work-family conflicts), and the personality of the

agent (all variables) were also statistically significant. This

last model explained 61 % of the variation in depression

between workplaces and 48 % between workers. Overall,

variation of depression between workplaces is no longer

significant.

Emotional exhaustion

Table 5 presents the results for emotional exhaustion.

Model 1 shows significant variation of the outcome at

both the worker and workplace levels. Workplaces

accounted for 5.2 % of the total variation in emotional

exhaustion. Model 2 reports associations for work vari-

ables and indicated statistical significance for skill util-

isation, psychological demands, irregular work schedule,

abusive supervision, interpersonal conflicts, harassment,

and job insecurity. Model 3 controls for family situation

and irregular work schedule and harassment lost their

significance. Model 4 controls for social support outside

the workplace, and harassment is now no longer signifi-

cant. In Model 5, personality of the agent is taken into

account and the results reveal no specific modifications

regarding the association between work variables an

emotional exhaustion. Model 6 contains all variables and

shows that skill utilisation, psychological demands, abu-

sive supervision, interpersonal conflicts and job insecurity

are associated with emotional exhaustion. Some family-

related variables (parental status, family–work conflicts,

work-family conflicts), and the personality of the agent

(age, physical health, internal locus of control) were also

statistically significant. Model 6 explained 69 % of the

variation in emotional exhaustion between workplaces and

49 % between workers. The percentage of variation left for

workplaces was 1.8 % (p \ 0.01).

At the end, multicollinearity tests were conducted

because of correlated independent variables in multilevel

regression models. Based on Model 6 of each outcome, the

variance inflation factor (VIF) ranged 1.10–2.58 with an

average of 1.49. These values are largely below theTa

ble

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123


Table 3 Results of multilevel regression modelling of psychological distress (unstandardised coefficients)

Model 1 Model 2 Model 3 Model 4 Model 5 Model 6

Constant 2.168** 2.157** 2.672** 2.807** 2.003** 2.671**

Work

Skill utilisation -0.075** -0.061* -0.072** -0.016 -0.018

Decision authority -0.111** -0.095* -0.118** -0.038 -0.057

Physical demands -0.117 -0.164* -0.111 -0.129* -0.135

Psychological demands 0.066** 0.022 0.067* 0.050** 0.026

Working hours 0.008 0.008 0.007 0.010 0.009

Irregular work schedule 0.063 -0.030 0.050 0.075 -0.003

Support colleagues -0.038 -0.005 -0.028 0.019 0.023

Support supervisor 0.085** 0.044 0.094** 0.064* 0.052

Abusive supervision 0.035** 0.027* 0.033** 0.030** 0.028*

Interpersonal conflicts 0.083 0.053 0.089** 0.040 0.029

Harassment 0.151 0.147 0.147 0.174 0.160

Recognition -0.095** -0.061 -0.091** -0.035 -0.024

Career perspective -0.046 -0.021 -0.043 -0.037 -0.019

Job insecurity 0.259** 0.181** 0.248** 0.188** 0.153**

Family

Marital status (in couple) -0.600** -0.543**

Presence of minor children -0.177 -0.117

Household income -0.029 0.006

Marital strains 0.496** 0.358**

Parental strains 0.365** 0.259*

Family–work conflicts 0.084** 0.034

Work–family conflicts 0.135** 0.083**

Network

Social support -0.782** -0.251

Agents

Gender (female) 0.330* 0.295*

Age -0.012* -0.010

Physical health 0.131** 0.110*

Alcohol 0.016* 0.016*

Smoking 0.011 0.005

Physical activities -0.104** -0.090**

Self-esteem -0.092** -0.074**

Internal locus of control -0.144** -0.110**

Childhood stressful events 0.084 0.072

Random part

Workplaces variance 0.081** 0.043 0.025 0.045* 0.062* 0.042*

Workers variance 6.797** 5.652** 5.123** 5.569** 4.797** 4.624**

q 0.012 0.008 0.005 0.008 0.013 0.009

Goodness-of-fit

v2 670.35** 1,445.65** 700.72** 1,183.99** 1,738.08**

df 14 21 15 23 31

R2 (workplaces) 0.250 0.368 0.252 0.278 0.366

R2 (workers) 0.172 0.252 0.184 0.294 0.322

Benjamin and Hochberg method corrected p values for multiple testing

* p \ 0.05; ** p \ 0.01


123


Table 4 Results of multilevel regression modelling of depression (unstandardised coefficients)


Constant 7.097** 7.098** 8.202** 9.673** 6.649** 8.671**

Work

Skill utilisation -0.321** -0.278** -0.309** -0.085 -0.098

Decision authority -0.176 -0.098 -0.200* 0.086 0.038

Physical demands -0.208 -0.379* -0.181 -0.317* -0.315*

Psychological demands 0.219** 0.070 0.222** 0.167** 0.089*

Working hours 0.010 0.008 0.006 0.012 0.006

Irregular work schedule 0.245 -0.035 0.194 0.262 0.044

Support colleagues -0.206* -0.097 -0.165 0.007 0.026

Support supervisor 0.173* 0.055 0.210** 0.061 0.058

Abusive supervision 0.145** 0.118** 0.139** 0.126** 0.123**

Interpersonal conflicts 0.280** 0.200* 0.303** 0.100 0.081

Harassment 0.280 0.237 0.254 0.332 0.249

Recognition -0.221* -0.138 -0.205* -0.006 0.007

Career perspective -0.181* -0.109 -0.166* -0.137* -0.103

Job insecurity 0.616** 0.314** 0.572** 0.321** 0.188

Family

Marital status (in couple) -1.031** -0.752*

Presence of minor children -0.799* -0.534

Household income -0.179** -0.029

Marital strains 1.271** 0.701**

Parental strains 1.030** 0.576*

Family–work conflicts 0.240** 0.048


Network

Social support -3.096** -1.492**

Agents

Gender (female) 0.935** 0.892**

Age -0.050** -0.050**

Physical health 0.618** 0.577**

Alcohol 0.057** 0.060**

Smoking 0.072** 0.057**

Physical activities -0.257** -0.222**

Self-esteem -0.421** -0.360**


Childhood stressful events 0.387** 0.334**

Random part

Workplaces variance 0.525 0.243* 0.013 0.199 0.090 0.000


q 0.010 0.006 0.000 0.005 0.003 0.000

Goodness-of-fit

v2 897.32 2,005.49 967.11 1,871.98 2,634.86

df 14 21 15 23 31

R2 (workplaces) 0.302 0.488 0.342 0.545 0.606

R2 (workers) 0.230 0.337 0.255 0.457 0.484


* p \ 0.05; ** p \ 0.01


123


Table 5 Results of multilevel regression modelling of emotional exhaustion (unstandardised coefficients)


Constant 1.674** 1.677** 1.742** 1.796** 1.593** 1.638**

Work

Skill utilisation -0.061** -0.059** -0.060** -0.039** -0.046**

Decision authority -0.026 -0.016 -0.027 0.001 -0.003

Physical demands -0.006 -0.026 -0.005 -0.005 -0.018

Psychological demands 0.102** 0.059** 0.102** 0.094** 0.058**

Working hours 0.002 -0.002 0.002 0.003 -0.001

Irregular work schedule 0.095** 0.021 0.092* 0.099** 0.033

Support colleagues -0.025 -0.009 -0.023 -0.007 -0.004

Support supervisor 0.000 -0.006 0.002 -0.009 -0.007

Abusive supervision 0.021** 0.021** 0.021** 0.018** 0.021**

Interpersonal conflicts 0.051** 0.045** 0.052** 0.034* 0.031*

Harassment 0.133* 0.084 0.132 0.129* 0.083

Recognition -0.028 -0.013 -0.027 -0.011 -0.002

Career perspective -0.025 -0.020 -0.025 -0.019 -0.019

Job insecurity 0.146** 0.088** 0.144** 0.126** 0.086**

Family

Marital status (in couple) 0.046 0.063

Presence of minor children -0.210** -0.194**

Household income -0.020 -0.008

Marital strains 0.062 0.029

Parental strains 0.076 0.062

Family–work conflicts -0.016 -0.032**


Network

Social support -0.144 0.034

Agents

Gender (female) 0.176** 0.115

Age -0.008** -0.008**

Physical health 0.106** 0.094**

Alcohol 0.006 0.007

Smoking 0.008 0.005

Physical activities -0.025 -0.018

Self-esteem -0.021* -0.017


Childhood stressful events 0.012 0.006

Random part

Workplaces variance 0.095** 0.022** 0.016** 0.022** 0.022** 0.017**


q 0.052 0.018 0.016 0.018 0.020 0.018

Goodness-of-fit

v2 973.52 1,754.94 978.28 1,308.69 1,927.96

df 14 21 15 23 31

R2 (workplaces) 0.595 0.683 0.597 0.623 0.687

R2 (workers) 0.335 0.459 0.337 0.400 0.488


* p \ 0.05; ** p \ 0.01


123


threshold of 4 (sign) or 10 (serious) indicating multicol-

linearity problems [13].

Discussion

This study has examined the contribution of the multilevel

determinants of workers’ mental health model, with an

emphasis on the role of the workplace context and work

organisation conditions on psychological distress, depres-

sion, and emotional exhaustion, when non-work and indi-

vidual factors are taken into account. The results support

the relevance of the proposed model that views workers’

mental health as being the product of stress caused by

constraints-resources brought to bear simultaneously by

structures of daily life and agent personality. As work is

concerned, the workplace level per se, accounts for a small

part of the variation in psychological distress (1.2 %),

depression (1.0 %) and emotional exhaustion (5.2 %).

Moreover, when indicators of constraints-resources in

structures of daily life and the personality of the agent are

controlled for, the variation in depression across work-

places is no longer significant, and only 0.9 % of the var-

iation in psychological distress, and 1.8 % in emotional

exhaustion remained between workplaces. Therefore,

workplaces are not strongly differentiating themselves on

the level of mental health symptoms reported by their

employees. Even if these small variances at the workplace

level may be attributable to the relatively small numbers of

workplaces (n = 63), the present study suggests that psy-

chological distress, and depression symptoms levels are

mostly comparable across organisations analysed here.

Nevertheless, emotional exhaustion symptoms, as the

major component of the burnout process, seems to be more

elevated in specific firms, since larger variations in emo-

tional exhaustion symptoms between workplaces were

observed compared to psychological distress and

depression.

Workers evaluation of work organisation conditions

prove to be important within workplace constraints-

resources associated with the three mental health outcomes

studied here. Constraints-resources were, however, asso-

ciated differently with the three outcomes. As for task

design, a higher level of skill utilisation is associated with

lower levels of depression and emotional exhaustion. This

is consistent with previous studies [37, 62, 72] and high-

lights the importance of designing task that motivate and

challenge the skill of workers. However, the level of

decision authority is not associated with outcomes when

other structures of daily life and personality of the agent are

taken into account. As for work demands, work hours and

schedule are not significant when controlled for family

situation, social support outside the workplace and

individual characteristics. Higher physical demands are

surprisingly related to a lower level of depression symp-

toms. Such a result may be explained by the way physical

demands were measured, as they were indexed with only

one item. It did not measure exposure to physical risk

(exposure to contaminants, dust, lifting heavy objects, etc.),

but more of the physical energy workers invested in their

task. Such investment may require a better physical and

general health to perform the job. For psychological

demands, they are associated with higher level of depres-

sion and emotional exhaustion symptoms. This is consis-

tent with previous studies [37, 59], but not with

psychological distress [72] when other structures of daily

life are accounted for. Regarding social relations, abusive

supervision clearly appears as an important stressor asso-

ciated with higher levels of psychological distress,

depression, and emotional exhaustion. Such a style of

supervision, based on sustained display of hostile verbal

and nonverbal behaviours, excluding physical contact [77],

is detrimental for mental health because supervisors are in

relationship with subordinates on a day-to-day basis, and

thus constituted a chronic stressor for those workers

exposed to it. We also found that interpersonal conflicts at

work were associated with a high level of emotional

exhaustion symptoms. Social support from colleagues and

the supervisor, as well as harassment, were not significant

after controlling for non-work factors and personal char-

acteristics. Concerning work gratifications, our results

confirmed, as some previous studies did [15, 18, 74], that

job insecurity is also a stressful condition associated with

elevated levels of psychological distress and emotional

exhaustion. However, neither job recognition nor career

perspectives associate with the three outcomes when fam-

ily situation, social support outside the workplace, and

individual characteristics are controlled for.

Results obtained here support the theoretical model

concerning the stressful role of constraints-resources

embedded in the other structures of daily life that include

family and social network outside the workplace. These

structures promote life experiences and the possibilities for

self-realisation, but they could also be sources of stress. All

constraints-resources with the family associate with any

one of the three outcomes, to the exception of family

income. Less mental health symptoms were found for those

living in couple (psychological distress, depression), hav-

ing children in the household (emotional exhaustion), and

experiencing family-to-work conflicts (emotional exhaus-

tion). However, stressful marital and parental relationships

within the household are marked by higher levels of psy-

chological distress and depression. As for work-to-family

conflicts, they appear to be an important chronic stressor,

because they relate to more symptoms for all mental health

outcomes analysed here. Family situation also modified the


123


relationship between work stressors and the three out-

comes. When family situation is controlled for in the

analysis, psychological distress is no longer associated with

psychological demands and support from the supervisor,

depression is no longer associated with psychological

demands and social support from both colleagues and

supervisor, and emotional exhaustion is no longer associ-

ated with irregular work schedule and harassment. Results

in Table 2 may suggest the apparent confounding effect to

be attributable to work-family conflicts as they are posi-

tively correlated with psychological demands, irregular

work schedule and harassment, while negatively associated

with support from colleagues and supervisor.

Concerning social support outside the workplace, it is

associated with less symptoms of depression, while the

relationships with psychological distress and emotional

exhaustion were not significant. Furthermore, when it is

controlled for, support from colleague is no longer signif-

icant with depression, and harassment lost its significant

effect on emotional exhaustion. Social support outside the

workplace seems to confound these associations, because it

is associated with higher level of support from the super-

visor, while there is as a small tendency to be related to less

harassment (see Table 2).

The results also confirm the role of the agent personality

in the theoretical model. Workers are not passive beings

who are subservient to the social conditions in which they

live since when they act, they bring with them constraints

and resources peculiar to them and shaped by their bodies,

minds, and social context. Being a woman was related to

more symptoms of psychological distress and depression,

while age was related to lower symptoms of emotional

exhaustion. Physical health problem on its side associated

with more symptoms for all outcomes, alcohol intake with

higher levels of psychological distress and depression, and

smoking with more symptoms of depression. Fewer

symptoms of psychological distress and depression were

found with higher level of physical activities, while self-

esteem (psychological distress, depression) and internal

locus of control (emotional exhaustion) were negatively

associated with the outcomes. Also, agent personality

apparently contributes to the confounding of skill utilisa-

tion (psychological distress, depression), decision authority

(psychological distress), support from colleagues and

supervisor (depression), and job recognition (psychological

distress, depression). According to correlations of Table 2,

the possible confounding effect seems to be attributable to

personality traits, because self-esteem and internal locus of

control are associated with higher levels of skill utilisation,

decision authority, support from colleagues and supervi-

sion as well with a higher level of job recognition.

The present study nevertheless has limitations. Firstly,

the data are cross-sectional, which implies that the observed

relationships cannot be interpreted causally and will need to

be replicated longitudinally. Some reverse causation might

be possible, as workers suffering from mental symptoms

may negatively evaluate their work conditions. Secondly,

we cannot rule out the possibility of a common method

variance bias, because all measurements were based on one

source. However, workers came from 63 different firms,

reducing therefore the bias attributable to measurements

based on one specific context [60]. We also conducted a

single unmeasured latent factor analysis with Mplus 7.11 as

suggested by Podsakoff et al. [60] to verify if the latent

factor accounted for variance and covariance between

measurements. Results gave v2 = 19,193.70, df = 528,

p \ 0.0001, suggesting the common method variance bias

to be small. Thirdly, results cannot be generalised to the

overall workforce as data came from a single insurance

company, but the 63 firms sampled were diversified in

terms of economic sectors, firm sizes, and unionisation.

Fourthly, the companies’ response rate of 41 % may also

have introduced a selection bias, such as company experi-

encing more problems with workers’ mental health might

have been more willing to participate in the study. How-

ever, the response rate was significantly higher compared to

the ones usually found in organisational research [9], and

the incidence insurance claims rate (2009–2012) for mental

health problems were not significantly different between

respondent and non-respondent companies. Fifthly, the

analysis does not take into account workplace factors

related to the physical environment (dust, noise, cold, heat,

toxic, etc.), human resources practices, health and safety

resources or other elements in the work contract that allow

employees to better balance work and family responsibili-

ties. Sixthly, while we controlled for gender differences in

the analysis, patterns of associations may be different

between genders and would need to be investigated in

future studies. Finally, psychological distress, depression,

and emotional exhaustion are all correlated. Independent

variables cannot be tested for difference in coefficients

across the three outcome variables [3], which would have

required the use of multivariate multilevel regression

models with a larger sample size at the companies’ level.

Therefore, the contribution of independent variables for

specifically psychological distress, depression and emo-

tional exhaustion will require further studies.

Despite these limitations, this study demonstrates that

the multilevel determinants of workers’ mental health

model explain a substantial part of the variance in psy-

chological distress, depression, and emotional exhaustion.

Based on this model, pathogenic work organisation con-

ditions, as estimated here, appear more important for

emotional exhaustion symptoms compared to psychologi-

cal distress and depression. Furthermore, the results of this

study clearly demonstrate that family situation, social


123


support outside the workplace, and personal characteristics

are also in and of themselves important factors associated

with workers’ mental health. Not only they associate with

mental health, they also modulate the number and the type

of work stressors that related to mental health symptoms.

In the end, we need to consider broadening approaches

in occupational mental health to avoid coming to erroneous

conclusions about the relationship between work and

mental health. Theoretical and empirical studies must

recognise the complexity of workers’ mental health deter-

minants if we want to be better able to capture and inter-

vene on what is going wrong with work organisation

conditions experienced by the worker. This study therefore

replies to previous claims that non-work and individual

factors must be integrated in occupational mental health

research to arrive at a better understanding of workers’

mental health problems [10, 16]. For example, if non-work

or individual factors appear as the primary explanation of

mental health symptoms of workers in a particular com-

pany, interventions on work conditions that will help better

coping with stressful life conditions will have a better

chance to be successful in reducing mental health symp-

toms. More research is thus needed to help the develop-

ment of diagnosis and corrective measures that will not just

focus on the work factor, but also on other structures of

daily life people are involved in, as well as individual

characteristics on which interventions are possible.

Acknowledgments This study was supported by the Canadian

Health Research Institutes under Grant number: 200607MHF-

164381-MHF-CFCA-155960, and the Fonds de recherche du Quebec-

Sante under Grant number: 13928. The authors also thank Standard

Life Canada for their help in workplace recruitment and Marie-Eve

Blanc and Julie Dextras-Gauthier for the field work.

Conflict of interest On behalf of all authors, the corresponding

author states that there is no conflict of interest.

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TC Transcontinentalimages.transcontinentalmedia.com/LAF/lacom/stress_vie... · 2014-09-17 · Alain Marchand • Pierre Durand • Victor Haines III • Steve Harvey Received: 24